...clinically significant and associated with intensive distress, impairment, social dysfunction or increased personal or public risk, however it must be unrelated to grief caused by recent personal loss, (4th ed., text rev.; DSM–IV–TR; American Psychiatric Association, 2000; Holt et al, 2012). The distinct criteria and descriptive information in the DSM-IV, enables clinicians to make quick diagnoses based on an individual’s symptoms. It can also be used in legal proceedings, to determine the mental state of individuals and ensure they receive appropriate sentencing in psychiatric care rather than prison. It is versatile and the only manual that strictly focuses on mental health which is why it is referred to as the Gold Standard of clinical diagnosis. The DSM-IV has also played a vital role in the development of research and treatments for mental health, which has improved many patients’ quality of life. Keenan et al. (2007) examined the reliability of the DSM-IV oppositional defiant and conduct disorder symptoms, in 3-5 year old children. The mothers were interviewed about their children’s current symptoms and results showed that the reliability of symptoms, measured by interrater and test-retest reliability, was moderate to high. However, the DSM-IV-TR (2000) 4th ed., text rev. emphasises that the diagnostic criteria are only guidelines and reliability is therefore determined primarily by the clinician’s interpretation of the information provided. In the...
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...Discuss issues surrounding the classification and diagnosis of depression (24 marks) A key concern regarding the diagnosis of depression is the reliability of the diagnosis; reliability refers to the consistency of a test or results. In order to increase the reliability of this, the test-retest method can be used to assess consistency. Within this, a patient is tested for depression twice over a period of time in order to establish whether or not the scores on the classification measure stay consistent; this would show a high concordance rate between test results. A strength of using the test retest method is that, if results have a low concordance rate from the two tests, it signposts that the patient is either getting better or worse in terms of their depression as their results have changed. For example, if a patient’s depression score decreases over time, it could signal to the psychiatrist that the treatment is working, and vice versa, if scores increase it can indicate that treatment is not working or the patient’s depression is getting worse, which tells them that they may need to make changes to help the patient. However, the problem with this is that some assessments have been shown to not consistently have good test-retest ability; predominantly this is the DSM-IV. This statement has been supported by research. For instance, Keller et al (1995) assessed 524 people with depression from inpatient, outpatient and community settings at 5 different sites. Within the study...
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...To alleviate the risks that are in the process of harming prospective parents, individuals who are living with a severe genetic condition, and society as a whole, the concerns surrounding Preimplantation Genetic Diagnosis must first be addressed. All patients need to be properly informed about the procedure including its benefits as well as its adversaries. To address effects of PGD on prospective parents, a “preventive” approach should be taken. In “Born and Made” by Sarah Franklin, American anthropologist, and Celia Roberts, Senior Lecturer and Co-Director of the Centre for Gender and Women's Studies in the Department of Sociology at Lancaster University, the “preventive” attitude is defined as “the effort to protect patients against having...
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...NURSING DIAGNOSIS NANDA Nursing Diagnosis (Problem/Human Response): Impaired physical mobility Related To (Etiology): compromised ability to move purposefully within the environment and reluctance to move secondary to pain As Evidence By (Supporting Evidence from your Assessment): unsteady gait, difficulty maneuvering effectively and pt stating pain at “6/10” SHORT TERM OUTCOME: (Patient will….by….) Evaluation Pt will verbalize understanding of the benefits of participating in PT and staying active, by end of shift. Pt will verbalize increased comfort, by end of shift. Met: increased comfort “5/10”; pt verbalized benefits of activity and PT. Unmet: In Progress: NURSING INTERVENTIONS (Nurse will) RATIONALE FOR NURSING INTERVENTION (cite ref). Effectiveness of Intervention 1. Pain medications as ordered, on time 2. Use pain assessment scale to identify intensity of pain. 3. Educate pt on benefits of therapeutic exercises and frequent physical activity. 1. Analgesic agents are more effective when administered early in the pain cycle. (Smeltzer, p.260) 2. Provides baseline for assessing changes in pain level and evaluating interventions. (Smeltzer, p.259, 260) 3. PT exercises assists in maintaining and building muscle strength, joint function, developing endurance, stimulating circulation and promoting relaxation. (Smeltzer, p.177) 1. Pt reported increased comfort rating pain at “5/10”, previously rated at “6/10” (I would...
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...Symptoms and Diagnosing of Autism Spectrum Disorder Stephanie R. South University of Cincinnati Abstract This paper explores the symptoms and how to accurately diagnosis of Autism Spectrum Disorder. Autism is classified as a psychological condition that starts in adolescence. Psychology classes, specifically an introductory course, briefly cover this condition and its diagnosis. This paper will provide a great knowledge and understanding of diagnosing Autism. There are many symptoms and signs exhibited in children diagnosed with Autism. There is no clear answer for why or how this disorder occurs, making it hard to properly diagnose those afflicted. It is extremely important for the child’s caregiver to be proactive and seek out medical expertise at the onset of behavioral issues in their child. Diagnosing the child at a younger age can ensure proper treatment and interventions for him/her. I have chosen to write my paper on the symptoms and diagnosing of Autism. This disorder is mysterious, but also fascinating. Being a mother, I worry all the time about new and strange afflictions that are attacking our children. To be proactive in our children’s lives, we must be knowledgeable and observant for the early warning signs or symptoms. Throughout the research process of preparing my paper, I have gained a greater comprehension of this disorder and the first indicators that has prepared me to act promptly for the sake of my children. In the last decade, Autism has gained...
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...to be standardized across psychology; however, the DSM-IV is not as precise for diagnosing personality disorders as some psychologists would like. Give an example of each of the following problems identified in your readings and explain how these problems could negatively affect a diagnosis. 1. Some criteria used for reaching a diagnosis cannot be observed directly. The DSM-IV has been criticized for diagnosing patients with disorders because of their reliability. A patient is diagnosed by a clinician based on the patient telling them their symptoms, when it is possible that the patient is exaggerating and this can result in a patient being mis diagnosed because the clinician may not have paid close attention to body language and actions from the patient. 2. Personality disorders can be similar to each other. A person can be diagnosed with one or more personality disorders because symptoms are related to one another according to the DSM-IV. With the symptoms of personality disorders being similar in nature to one another it does make it hard to diagnose a person with a single personality disorder according to the DSM-IV. 3. People with different personalities can be given the same diagnosis. Each person is different so therefore one person’s symptoms may not be the same as another person. The DSM-IV does not account for a person’s individuality. An individual’s personality affects how they react to different situations in life, this can lead to a misdiagnosis by a clinician...
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...for several years. In order to identify the etiology of the symptoms Matt was experiencing, Dr. Hemo referred him to the hematology-oncology department at his local hospital. The cause of these symptoms needed to be determined to reach a diagnosis. The phlebotomist drew the first blood specimen for the CBC, which indicated a problem. The results of the complete blood count showed that Matt’s blood count was below normal ranges. The MCV and MCHC tests showed that Matt’s RBC count was low. The low red blood count pointed to a diagnosis of anemia. After this series of blood tests, it was determined that he had cancer in his bone marrow and blood. Matt was diagnosed with chronic myelogenous leukemia. Matt started taking tyrosine kinase inhibitors to stop the cancer cells from growing. He takes the TKIs orally, and has experienced side effects including nausea and diarrhea. The feeling of unease often leads to emesis. Matt’s body experiences dehydration from the vomiting and the frequency of the loose bowel movements. At this time when his body is lacking the essential water and salts, he becomes very weak. Bone marrow transplantation is the next step that will be taken, to replace the damaged bone marrow. Matt is coping with his recent diagnosis with CML, but his friends are having a difficult time accepting the news. Matt’s friends are devastated, as they have heard of many cases of carcinoma ending in tragedy. They had older family members diagnosed with many forms of cancer, but...
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...Suggest 2 improvements that could be made to the Griffiths study and outline any implications these changes may have. (8) One change would be to replicate the study in different countries. Pseudo patients could see if they would be diagnosed as having schizophrenia by doctors in England, France and Canada. The pseudo patients would provide the same symptoms as in the original study (thud, hollow and empty). This would allow the researcher to investigate any cross cultural differences in diagnosis and the treatment of patents (if admitted to a hospital). An implication of this may be that doctors in the other countries may make the same mistakes with diagnosis thus showing practitioners to be bias cross cultural. This would give further support for the need of the DSM to be updates and would mean that the results form Rosenhan's study could be generalised to other countries. In addition to this it would provide insight into treatments used in the different countries, they may find that the type of care/ standard of care differ from country to country (possibly worse in counties with lower economy) Another improvement could be to set up CCTV cameras into the hospitals to record the behaviours of the staff towards the patients. This would be overt at first as the staff would be aware the cameras are being brought in, however they would soon forget they are there. This would allow Rosenhan to have a record of staff patient interaction and the treatment of the pseudo patients...
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...pre-adoption? When was she adopted? How did the process go? How specifically have her eating and sleeping patterns changed? What is she throwing tantrums over? Describe the tantrums and situations during and before they happen. 2. In addition to the clinical interview, what other clinical assessment tools should you consider? Why? Which ones would you not consider? Why? I’d start off with observation of the family in a natural environment concentrating on not only Clara but her parents as well. 3. If you were preparing to diagnose Clara, you would refer to the DSM-IV classification system to evaluate her condition on five separate axes. What type of information would go into each axis? Note: You are not asked to enter a diagnosis, only describe the kind of information that would be entered in each axis.) Clara is a child who is adopted. She’s having control and/or anger issues in the form of tantrums and her natural sleeping and eating patterns have been disturbed 4. Do you...
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...Awareness is important to me because even when a patient has the most common form of dysautonomia, postural orthostatic tachycardia syndrome (POTS), it takes an average of 4 years before the correct diagnosis is identified. Unfortunately, being diagnosed properly does not always mean a patient will get better. Due to a lack of awareness of how prevalent this condition is, very little research is funded by our government, so we still have no cure. Treatments currently available can give back some quality of life, but are not a cure and do not work for all patients. If a root cause can be identified, sometimes treating that helps resolve dysautonomia symptoms. I became ill in 2008 at the age of 18 and slowly became more and more sick. Due to the lack of awareness about dysautonomia, it took 4 years (and 20+ doctors) from first becoming ill before I was diagnosed with POTS. In the years after diagnosis I saw many doctors and even went to Mayo Clinic. Over 30 different treatments were tried, but my condition got worse and worse until I couldn't do basic things like grocery shop for myself....
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...starts in the tissues of the pancreas and because the pancreas is a gland, the most common type of pancreatic cancer is adenocarcinoma. Adeno means relating to a gland and carcinoma is cancer, so adenocarcinoma is cancer of a gland. (Mandal, Dr.) The average age of people with pancreatic cancer is between 70 and 80, and it is more common in men than women. There are two ways a pancreatic cancer can be diagnosed; clinically and pathologically. A clinical diagnosis is done by radiology and or the physician’s evaluation by lab test and the physical exam. A pathological diagnosis is by taking a tissue sample from the primary or metastatic (cancer spread) site and having a pathologist exam the tissue. By looking at these cells, the pathologist can tell if there is cancer and what the primary site is. Because the pancreas is located deep within the body, it is hard for a physician to feel any masses or abnormalities of the pancreas so additional diagnostic procedures are required. The most common way to obtain a clinical diagnosis of pancreatic cancer is with a CT scan. These scans have the ability to see if there are any masses in the pancreas, the size of the mass, if it has spread or involves any other organs. ("How is pancreatic," 2013) There...
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...Discuss issues of reliability and validity associated with the classification and diagnosis of schizophrenia (8+16) One issue related to classification and diagnosis is reliability. Reliability refers to the consistency of a measuring instrument like DSM that is used when diagnosing schizophrenia. It can be measured by the extent to which psychiatrists can agree on the same diagnosis when independently assessing patients (inter rater reliability). The use of DSM III in 1990 was believed by Carson to have fixed any problems of IRR. Therefore the system is now more advanced with the DSM 5, there would be much greater agreement over who did and didn’t have schizophrenia by comparing the diagnosis which would make it reliable. However there is little evidence that DSM is routinely used with high reliability by mental health clinicians. For example Whaley found that IRR between health professionals were low as .11 between different raters. This suggests that when independently assessing patients the diagnosis was rarely consistent between them, meaning the DSM tool is unreliable in accurately and consistently diagnosing schizophrenia. There are also cultural differences about the interpretations of schizophrenia which poses a threat to reliability of the diagnosis of schizophrenia. For example Copeland et al gave a description of a patient showing clinical characteristics associated with schizophrenia to US and UK psychiatrists. From the US psychiatrists 69% diagnosed the patients...
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...evidence. A well-built PICOT question increases the likelihood that the best evidence to inform practice will be found quickly and efficiently. Templates and Definitions for PICOT Questions5, 6 Question type Definition Template Intervention or therapy To determine which treatment leads to the best outcome In _____________________ (P), how does ______________ (I) compared with _________ (C) affect __________________ (O) within _________________ (T)? Etiology To determine the greatest risk factors or causes of a condition Are ______________________________ (P) who have ________________________ (I), compared with those without ________ (C), at ____ risk for ____________________ (O) over _____________________________ (T)? Diagnosis or diagnostic test To determine which test is more accurate and precise in diagnosing a condition In ______________________________ (P), are/is ___________________________ (I) compared with ___________________ (C) more accurate in diagnosing _______ (O)? Prognosis or prediction To determine the clinical course over time and likely complications of a condition In ___________________ (P), how does ____________ (I) compared with ________ (C), influence _____________ (O) over _________________ (T)? Meaning To understand the meaning...
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...affect a diagnosis. 1) Some criteria used for reaching a diagnosis cannot be observed directly. A patient analysis could take place in most cases so that a clinician could gain information about the patient’s symptoms that may be immediately observable in the clinical setting. If this information is not gathered by the clinician a misdiagnosis could be made. Subjective data may include information about the patient’s personality, behaviors or a patient’s reaction to information that cannot be directly from the patient due their inability or reluctance to speak with clinician directly. As an example, if a patient who did not present personality disorders in fear might be diagnosed as having a social phobia. A patient not being truthful has very serious consequences and one could not get the appropriate treatment needed. 2) Personality disorders can be similar to each other. There are several symptoms that overlap between different disorders in DSM listings. A clinician’s personal observation could misdiagnosis between one of these two disorders if the clinician relies only on information gathered in a clinical setting. Disorders such as obsessive-compulsive, anxiety, and personality disorder have many symptoms that are alike. If this was the case a clinician could misdiagnosis and treats the patient incorrectly giving improper medication and the wrong types of therapy. 3) People with different personalities can be given the same diagnosis The DSM-IV...
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...system for categorization of subtypes of ischemic stroke mainly based on etiology has been developed for the Trial of Org 10172 in Acute Stroke Treatment (TOAST). A classification of subtypes was prepared using clinical features and the results of ancillary diagnostic studies. "Possible" and "probable" diagnoses can be made based on the physician's certainty of diagnosis. The usefulness and interrater agreement of the classification were tested by two neurologists who had not participated in the writing of the criteria. The neurologists independently used the TOAST classification system in their bedside evaluation of 20 patients, first based only on clinical features and then after reviewing the results of diagnostic tests. The TOAST classification denotes five subtypes of ischemic stroke: 1) large-artery atherosclerosis, 2) cardioembolism, 3) small-vessel occlusion, 4) stroke of other determined etiology, and 5) stroke of undetermined etiology. Using this rating system, interphysician agreement was very high. The two physicians disagreed in only one patient. They were both able to reach a specific etiologic diagnosis in 11 patients, whereas the cause of stroke was not determined in nine. The TOAST stroke subtype classification system is easy to use and has good interobserver agreement. This system should allow investigators to report responses to treatment among important subgroups of patients with ischemic stroke. Clinical trials testing treatments for acute ischemic stroke...
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